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  • Traumatic pelvic fractures require high-energy trauma, thus look for other associated injuries.

  • Reduction of a hip dislocation should take place within 6 hours of the injury.

  • Legg–Calvé–Perthes disease is an idiopathic avascular necrosis (AVN) of the femoral head.

  • A spiral femur fracture in a nonambulatory infant or child suggests child abuse.

  • Distal femoral epiphyseal fractures in children can cause lower extremity growth disturbances.

  • Spiral tibial shaft fractures are termed toddler’s fracture in those just learning to walk.

  • The most common fracture of the talus is in the neck, which occurs from forced dorsiflexion. This injury is often complicated by AVN.

  • Lisfranc fracture occurs at the base of the second metatarsal, where the stability of the midfoot is maintained.

  • The Jones fracture is a metatarsal neck fracture distal to the apophysis of the base of the fifth metatarsal.


The young pelvis has a great amount of cartilage and pliability and can absorb tremendous amounts of energy without resulting in a fracture. Pelvic fractures in children usually require high-energy trauma mechanisms such as automobile versus pedestrian, motor vehicle crashes, or significant falls. The violent forces required to cause pelvic fractures often result in multisystem trauma accompanied by visceral organ damage, limb fractures, and/or urogenital injuries. Morbidity and mortality rates following pelvic fractures in children are much lower than those seen in adults. Obese youth are more likely to suffer pelvic injuries if their BMI ≥95%.1

The recognition and stabilization of any accompanying injuries is the most pressing issue surrounding pelvic injuries in the emergency department (ED). Traumatic, high-energy pelvic fractures are classified depending upon their involvement of either the pelvic ring or the acetabulum. Pelvic ring fractures can be classified as either stable or unstable. Stable injuries include single breaks in the pelvic ring, diastasis of the pubic symphysis, and fractures of the iliac wings. Stable fractures may be successfully managed nonoperatively with protected weight bearing. Unstable injuries include those with two breaks of the pelvic ring (Fig. 32-1) or those having a sacroiliac dislocation/fracture along with an associated rami or pubic symphysis fracture. Unstable fracture patterns often require external fixation or open reduction/internal fixation to stabilize the bony injury while allowing for better management of associated injuries.

FIGURE 32-1.

Bilateral pelvic rami fractures which are unstable and at high risk for accompanying visceral injuries.

Fractures of the acetabulum are rare in children and result from forces transmitted through the femoral head. The acetabulum will usually fracture where the triradiate cartilage meets the pelvis (Fig. 32-2). Like pelvic ring fractures, these injuries are usually associated with high-energy trauma. Any acetabular fracture associated with a pelvic ring fracture is considered unstable. Many acetabular fractures are associated with hip dislocations. Dislocations of the hip may be evident in the ED ...

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